Zero deaths in some cities. Thousands in others. The pandemic’s fault lines continue to widen as vaccines flow toward rich countries.

By Weiyi Cai, Lazaro Gamio, Lauren Leatherby and Allison McCan

The pandemic’s disparities have never been this stark.
Much of the world’s vaccine supply continues to be used or stockpiled by countries that have already made steady progress, even as outbreaks in the developing world are raging. With almost half of residents vaccinated, New York City and London are preparing to welcome tourists this summer, while Cape Town waits to administer its first vaccine doses to non-medical workers.
Vaccines are not the only tool to control the spread of infection, and some areas — particularly those across Asia and Oceania — have kept cases low without them. But this year, no factor has determined a nation’s path out of the pandemic more than the vaccines it can buy.
It wasn’t always this way. A few months ago, outbreaks were exploding across major European and North American cities, and fledgling inoculation campaigns were no match for the spread of new variants. India’s leaders, meanwhile, boasted that they had triumphed over the virus.
But an analysis of vaccination campaigns and case trajectories across 22 global cities shows how the picture has changed over the last few months. Cases remain an imperfect measure — rates of testing vary widely and many infections are missed. But the broad outlines are unmistakable: The pandemic is splitting into haves and have-nots.
Two countries with surging epidemics have played central roles seeding outbreaks across their regions: India and Brazil. Neither is vaccinating fast enough to keep things under control.

In India, infections have skyrocketed across Delhi and Goa, and outbreaks are spreading quickly to more rural areas, in one of the deadliest waves since the start of the pandemic. Testing is spotty, and the case numbers only hint at the true scale of the problem.
“Every event in India is a super-spreader event,” said Dr. S.V. Subramanian, a professor of population health and geography at Harvard University.
India started vaccinating later than many major Western nations, and just 10 percent of its 1.4 billion people have received at least one dose. And the pace of vaccinations has slowed dramatically in recent weeks, even as the country halted vaccine exports to vaccinate more people at home. Donated vaccines from the United States and other countries are too few to stop the current epidemic.
Now India’s outbreak, along with a potentially more contagious variant of the virus first detected there, appears to be spreading to neighboring countries, which are once again imposing strict national lockdowns.
An uncontained outbreak in Brazil has helped to spur a new wave throughout Latin America, which was already one of the hardest-hit regions in the world. Vaccines are limited, health care systems are weak, and the political will to keep people home and economies closed has waned.
In New York City, London and Tel Aviv, nearly half of residents have received a first dose of a vaccine. Those rates, paired with significant natural immunity acquired from past outbreaks, have helped to push down outbreaks to levels not seen for a long time.
Vaccines did not act alone. Restrictions were critical in bringing case numbers down from their peaks, experts say.
From January through early April, the United Kingdom implemented a strict national lockdown, closing schools and nonessential shops, and ordering everyone to stay at home. Israel tightened restrictions in early January, even as vaccines were being rapidly doled out. And Los Angeles faced stay-at-home orders until late January, by which point cases had fallen by about half since their peak earlier that month.
The rapid vaccination campaigns in these cities and others like them means they are likely to be shielded from dire outbreaks in the future.
The picture looks slightly different in Santiago, Chile, where cases recently saw a slight uptick despite high vaccination rates.
Part of the difference may be due to Chile’s reliance on the Sinovac vaccine, which has a comparatively low efficacy rate after just one dose. Still, data shows the vaccine rollout appears to be working: Cases, deaths and hospitalizations are falling among older Chileans, those most likely to be fully vaccinated.

Some of the world’s slowest vaccine rollouts are in places that have had the most success in controlling the virus. In much of East Asia and Oceania, control measures have kept community transmission almost completely at bay.
Vaccination rates in the region lag behind other wealthy countries, in part because the comparatively low infection rates make the vaccine rollout less urgent. Countries like South Korea and Japan — where just 7 percent and 3 percent of their populations have received at least one dose — also rely on vaccines developed and manufactured elsewhere.
Governments that have successfully managed the virus this long may have success maintaining low transmission to accommodate slower vaccination campaigns. But even small outbreaks offer a warning sign that slow vaccination efforts leave them vulnerable.
Bangkok is battling its largest outbreak since the pandemic began, recording nearly half of Thailand’s new cases. Officials said new clusters were detected in some of the city’s most crowded communities, and now the outbreak threatens two major prisons. Schools, cinemas, gyms, pubs and bars in the capital remain closed, and if there are two or more people in cars — even family — they must wear masks.
Other major cities are in a holding pattern: Their vaccine rollouts are not among the world’s fastest, but at least 10 percent of their population is fully vaccinated, better than most of the world. Outbreaks continue to simmer, but new case counts are much lower than at the worst points during this winter and spring.

But the progress is tenuous. Cases are comparatively low in Rome, Prague and Paris, but so are vaccination rates, leaving those cities vulnerable to another surge. Toronto has extended lockdowns. Istanbul’s cases have dropped after a national lockdown, but reporting from Turkey has been inconsistent throughout the pandemic, making it unclear how much of its outbreak has receded.
Several countries in Africa have some of the lowest vaccination rates in the world. A global vaccine-sharing effort known as Covax has only been able to deliver limited numbers of vaccines, and in many African nations, only health care and frontline workers have been inoculated.
Globally, 18 vaccine doses have been administered for every 100 people, but that number is just 1.6 doses for every 100 African residents, more than 30 times lower than the North American rate. In Nigeria, Ethiopia, Egypt and the Democratic Republic of Congo, the continent’s most populous countries and together home to half a billion people, just over 4.3 million doses have been distributed.

Case counts are currently low, but experts warn that data is spotty and testing capacity is particularly limited across much of the continent, making it difficult to assess the current trajectory. But the slow pace of vaccinations leaves the continent susceptible to more outbreaks.